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TL;DR:
Cushing’s disease, also called hyperadrenocorticism, is a hormonal disorder where the adrenal glands produce too much cortisol, a stress hormone that affects metabolism, immune function, and behavior. This condition is most common in middle-aged to older dogs.
The final stage of Cushing’s disease in dogs often includes more than just textbook symptoms or clinical signs. Many dogs begin to struggle with mobility, constant accidents, collapsing and/or a sharp drop in energy.
If your dog has been living with Cushing’s, this guide will help you recognize the real-life signs, understand your care options, and know when it may be time to consider euthanasia. You’re not alone and there are ways to make this stage more peaceful for both of you.
What the Final Stages of Cushing’s Disease Really Look Like
Those familiar with the progression of Cushing’s disease will note that dog’s may have some very common similarities such as developing a pot-bellied appearance; hair loss, thinning and/or even color change, increased appetite and/or drinking and urination (polyuria/polydipsia or PU/PD),panting, muscle weakness, and skin infections and/or frailty.
The end of Cushing’s disease doesn’t always follow a predictable path.But in the final stages, what pet parents really notice are things like:
- Sudden weakness or collapsing during short walks or when getting up
- Constant pacing or confusion. Your dog might walk in circles or seem lost in familiar spaces
- Refusing food, even favorite treats
- Frequent accidents, especially overnight
- Disengagement from family or lack of interest in toys, walks, or being touched
In many cases, these symptoms are tied to advanced changes in the pituitary gland (which signals the adrenal glands) or to an adrenal tumor, both of which can worsen over time if left untreated.
You may also start to notice a “change in the eyes”—a distant, foggy look that’s hard to describe but feels unmistakably different. Some dogs also develop secondary conditions like infections or respiratory issues that compound their suffering.
It’s not always dramatic. Sometimes it’s a slow, heartbreaking realization: They’re just not themselves anymore.
Some Real-Life Examples
1. Loss of Appetite and Extreme Lethargy
A 12-year-old Labrador who once devoured every meal now won’t eat—even favorite treats.
Why it matters: Labs are notorious for their appetite. When a Lab refuses food, it often means the body is in serious decline.
2. Frequent Accidents Indoors
A senior poodle urinates inside several times a day, even after just going outside, and no longer reacts to being called.
This can also be linked to increased urination, a common symptom in Cushing’s due to hormone imbalances affecting kidney function and thirst regulation.
Why it matters: House-trained dogs losing control or awareness signals cognitive changes, discomfort, or both.
3. Restlessness, Panting, and Anxiety
A border collie paces all night, pants excessively even in cool weather, and startles at small noises.
Why it matters: Dogs in distress often can’t rest. Panting at rest or in a cool room indicates pain, anxiety, or endocrine imbalance.
4. Recurring Skin Infections
A beagle develops open wounds and constant hotspots that don’t heal despite vet care.
Chronic hair loss and slow-healing wounds are also common in dogs with elevated cortisol levels, which can suppress the immune system and impair skin repair.
Why it matters: Cushing’s suppresses the immune system, and persistent skin issues can signal the body is no longer able to recover.
5. Collapse and Confusion
A terrier collapses after short walks, stares into corners, and sometimes seems “not there.”
Why it matters: Collapse or disorientation shows that both the body and brain are being impacted. These are late-stage signs that quality of life is rapidly declining.
What Care Looks Like in the Final Stages
When a dog enters the last stages of Cushing’s disease, the focus changes from managing the condition to keeping your dog as comfortable and supported as possible.
At this point, care becomes less about medications and more about presence, comfort, and daily quality of life. You’re not trying to “fix” things but to ease the strain.
Small changes can make a big difference:
- Add rugs or traction mats to help with slipping.
- Keep a consistent, calm routine.
- Offer soft, palatable foods Track their daily comfort using a simple checklist.
- Have honest conversations with your vet about what comes next.
If your dog has been on treatment options like trilostane (a drug commonly used to reduce cortisol levels), your vet may reassess whether continuing treatment is appropriate based on your dog’s appetite and energy levels.
At this point, your vet may also guide you through preparing for hospice-style care or the in-home euthanasia option.
When Does It Stop Being “Manageable”?
Track your dog’s comfort and quality of life over time and ensure that the following are true:
☐ Eating at least half of their usual meals
☐ Able to walk without falling or extreme effort
☐ Resting comfortably without panting or pacing
☐ Still responds to your voice or touch
☐ Seems to have more good days than bad
☐ Not showing signs of pain (whining, restlessness, hiding)
☐ You feel able to manage their care without burnout
If you’re checking “no” to several of these, it may be time to talk about what comes next.
Considering Euthanasia
At some point, the question shifts from “How do we treat this?” to “Are they still comfortable?”
This is often one of the hardest decisions a pet owner will ever make. But it can also be a final act of love: giving your dog peace when their body is no longer able to rest, recover, or enjoy life without distress.
If you’re unsure what this process involves, we’ve created a detailed guide that walks you through what to expect and how to prepare:
How Does Pet Euthanasia Work – What Happens and What to Expect
If you’re in the Portland, Oregon area, Compassionate Care offers 24/7 in-home pet euthanasia—so your dog can stay calm and comfortable in their favorite place, with you by their side. We’re here to help you talk it through and make the decision when you’re ready.
FAQs About Cushing’s Disease in the Final Stage
How is Cushing’s disease diagnosed?
Most cases are diagnosed using blood tests that measure cortisol levels, including an ACTH stimulation test. This helps your vet understand how your dog’s adrenal system is functioning and confirm if treatment is needed.
Is there a difference between typical aging and late-stage Cushing’s symptoms?
Yes. While aging dogs may slow down gradually, late-stage Cushing’s often causes sudden or extreme changes, like rapid muscle loss, obsessive pacing, or recurring infections, that go beyond normal senior changes.
Do dogs with Cushing’s disease know they are sick?
Dogs may not understand illness the way humans do, but they often sense discomfort or changes in their routine. In late-stage Cushing’s, many dogs appear anxious, withdrawn, or unsettled. These are signs they’re no longer feeling secure in their bodies.
Can late-stage Cushing’s cause neurological symptoms?
Yes. Advanced Cushing’s can sometimes lead to confusion, circling, head pressing, or staring into space, especially if a pituitary tumor is involved. These signs may indicate the brain is being affected.
Should I still give medications in the final stage of Cushing’s?
It depends. If your dog is no longer eating, vomiting, or experiencing side effects, it may be time to shift away from disease-targeted meds and focus on palliative care. Talk to your vet about what’s still helping versus what may be adding stress.
Is late-stage Cushing’s painful for dogs?
While Cushing’s itself isn’t always painful, the complications can be. Muscle loss, infections, anxiety, and internal organ strain can cause discomfort or distress, especially if symptoms are unmanaged.
Can dogs recover from late-stage Cushing’s?
Once a dog enters the final stages, recovery is unlikely. Focus shifts to keeping your dog as comfortable as possible and preparing for decisions like hospice care or euthanasia.
DVM’s Words vs. What It Means:
Veterinarians may use complex terms when talking about Cushing’s.
Here’s a quick cheat sheet to make it easier to understand:
- Hyperadrenocorticism = Cushing’s disease (too much excessive cortisol)
- Pituitary-dependent Cushing’s = Most common type, caused by a tiny tumor in the brain that overstimulates the adrenal glands
- Adrenal tumor (Adrenal-dependent Cushing’s) = A less common form caused by a tumor on one adrenal gland, which produces cortisol independently
- ACTH stimulation test = A diagnostic blood test to see how the adrenal glands respond to stimulation (helps diagnose Cushing’s)
- Trilostane = A common medication used to reduce cortisol levels
- Mitotane = An older treatment option that destroys part of the adrenal cortex to reduce cortisol
- High-risk breeds = Dachshunds, poodles, boxers, and terriers have a higher risk of developing Cushing’s due to genetic predisposition
